Purpose: Fulminant myocarditis (FM) could lead to fatal outcomes. To improve survival, patients are offered veno-arterial extracorporeal life support (VA-ECLS). One serious complication of FM is arrhythmia; however, the prognostic impact of severe arrhythmia is uncertain. Thus, the objective is to evaluate if serious arrhythmia in FM patients on VA-ECLS is associated with increased 30-day mortality. Methods: This is a multi-centre retrospective study including FM patients on VA-ECLS. Serious arrhythmias prior to or during VA-ECLS support include ventricular tachycardia (VT), ventricular fibrillation (VF), and third-degree atrioventricular block (3AVB). We used Wilcoxon Rank Sum test for continuous variables and Chi-Square test for categorical variables to compare baseline characteristics between patients with and without arrhythmias. To test the association between serious arrhythmia, including VT, VF, and 3AVB, and 30-day mortality, we performed Kaplan-Meier survival analysis using log-rank test and multivariable Cox proportional hazard (PH) model, adjusted for age, sex, troponin, and cardiac arrest. Results: Among 341 patients, median age was 44 (25th-75th percentile 31-57) years, 48% were males, and 35% received steroids. Overall, 30-day mortality was 35% (n=120 patients) and 120 (35%) of patients had arrhythmia. Patients with arrhythmia experienced higher frequency of cardiac arrest pre-ECLS (44% vs 29%, OR 1.90, 95%-Cl 1.20-3.01) and had higher troponin levels (median 17,500, 5,203-42,730 vs 5,897, 870-24,847, p<0.001). By multivariable analysis, patients with arrhythmias had significantly higher mortality during VA-ECLS support (36% vs 25%, OR 1.69, 95%-Cl 1.04-2.73) and significantly higher 30-day mortality. At 30 days post-VA-ECLS, 52 patients (43%) with arrhythmia while 68 patients (31%) with no arrhythmia died (HR 1.49, 95%-Cl 1.03-2.15). Conclusion: Severe arrhythmias are frequent in patients with FM requiring VA-ECLS and associated with increased 30-day mortality. The presence of arrhythmia could reflect more severe inflammation or hemodynamic compromise, warranting more aggressive management. Thus, these results can inform prognosis and help physicians identify high-risk patients who may require closer monitoring.
Serious Arrhythmia Increased 30-Day Mortality in Patients with Fulminant Myocarditis on Veno-Arterial Extracorporeal Life Support
Loforte A;
2026-01-01
Abstract
Purpose: Fulminant myocarditis (FM) could lead to fatal outcomes. To improve survival, patients are offered veno-arterial extracorporeal life support (VA-ECLS). One serious complication of FM is arrhythmia; however, the prognostic impact of severe arrhythmia is uncertain. Thus, the objective is to evaluate if serious arrhythmia in FM patients on VA-ECLS is associated with increased 30-day mortality. Methods: This is a multi-centre retrospective study including FM patients on VA-ECLS. Serious arrhythmias prior to or during VA-ECLS support include ventricular tachycardia (VT), ventricular fibrillation (VF), and third-degree atrioventricular block (3AVB). We used Wilcoxon Rank Sum test for continuous variables and Chi-Square test for categorical variables to compare baseline characteristics between patients with and without arrhythmias. To test the association between serious arrhythmia, including VT, VF, and 3AVB, and 30-day mortality, we performed Kaplan-Meier survival analysis using log-rank test and multivariable Cox proportional hazard (PH) model, adjusted for age, sex, troponin, and cardiac arrest. Results: Among 341 patients, median age was 44 (25th-75th percentile 31-57) years, 48% were males, and 35% received steroids. Overall, 30-day mortality was 35% (n=120 patients) and 120 (35%) of patients had arrhythmia. Patients with arrhythmia experienced higher frequency of cardiac arrest pre-ECLS (44% vs 29%, OR 1.90, 95%-Cl 1.20-3.01) and had higher troponin levels (median 17,500, 5,203-42,730 vs 5,897, 870-24,847, p<0.001). By multivariable analysis, patients with arrhythmias had significantly higher mortality during VA-ECLS support (36% vs 25%, OR 1.69, 95%-Cl 1.04-2.73) and significantly higher 30-day mortality. At 30 days post-VA-ECLS, 52 patients (43%) with arrhythmia while 68 patients (31%) with no arrhythmia died (HR 1.49, 95%-Cl 1.03-2.15). Conclusion: Severe arrhythmias are frequent in patients with FM requiring VA-ECLS and associated with increased 30-day mortality. The presence of arrhythmia could reflect more severe inflammation or hemodynamic compromise, warranting more aggressive management. Thus, these results can inform prognosis and help physicians identify high-risk patients who may require closer monitoring.
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Arrythmia Miocarditits ECMO multicenter.pdf
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Descrizione: Arrytthm Myocarditis ECMO Canada
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